Wednesday, July 22, 2015

Why are some IVF doctors so careless ?

New IVF clinics are springing up left, right and centre all over the country. Gynaecologists feel that IVF is a very lucrative specialty and they all want to start their own IVF clinic, rather than refer their patient to an IVF specialist. After all, why lose that income? And it seems to be such an easy thing to do ! All you need to do is buy the equipment , and then you are ready to start ! Most of these are senior gynaecologists, and after years of practice, they are quite rich . They are quite happy to attend a one week workshop, which makes them IVF specialists , and then find some freelancer who will travel to their clinic and provide them with the IVF services which they require.

Sadly, they grossly underestimate the amount of time and energy it takes to run an IVF clinic , and they often end up with very poor success rates. However, most of them are not even willing to acknowledge the reality that they are doing their patients a major disservice. Not only do they end up fooling their patients, they end up fooling themselves ! They justify their dismal pregnancy rates by saying their patients are very difficult ; or that the batch of injections used for superovulation was bad; or that the culture medium was poor quality; or that the incubator did not work well - anything or anyone , other than themselves.

They refuse to take responsibility for what’s happening , and I think this is partly because they have a guilty conscience . They know that they are doing a bad job, and they start covering up the truth. Not only do they not share any information with their patients, they actually lie to them ! They don’t tell patients how many follicles are growing on the scan, or how many eggs they’ve retrieved , or how many embryos they transferred. Some even go to the extent of manipulating the number, so they can "donate" extra eggs and embryos to other patients.

They don’t bother to give patients IVF treatment summaries ; or discharge records ; or photos of the embryos - and this is the same gynaecologist who always provides the patient with a DVD of the laparoscopy; or with a written summary when he does any other medical procedures, such as a D&C or a Caesarean Section ! Even if he does provide a summary of the IVF treatment, it’s done so poorly that the documentation is not even worth the paper which it is written on. Complaining afterwards does not help, since the damage is already done.

There is a lot of fudging during the IVF treatment, and gynaecologists get away with this sloppiness for two reasons. One is that their patients aren’t smart enough to demand better. Sadly, IVF patients don’t know what they should expect, and when they end up blindly trusting their doctor, many get taken for a ride.

Even worse, sometimes these doctors don’t understand the damage they do. They feel - So what if the embryo died ? So what if the patient didn’t get pregnant - it’s not the end of the world. These same doctors would never have the guts to set themselves up as gynaecological oncologists or start treating patients with cancer of the cervix after attending a one week course, because they understand that oncological surgery requires special technical skills which they don’t have . Cancers can be life threatening , and this is why they stay away from that field . However, they take a much more casual approach towards acquiring IVF skills, because they feel that there is much less at stake. IVF is deceptively easy to do , but they don't realise that doing it well requires experience, expertise and full-time dedication.

Sadly. a lot of IVF patients end up paying the price for this attitude. It's true that when an IVF cycle fails, the patient doesn’t die (unlike a badly performed Wertheim's hysterectomy for cancer cervix, where the surgeon reduces the patient's life expectancy significantly) . However, a failed IVF cycle does cause the death of the patient’s hopes and dreams . The biggest tragedy is that if the patient had gone to a good IVF clinic, she would have got pregnant, but a bad IVF clinic killed her chances.

One solution is introducing some sort of regulation to ensure quality control, but given the way the Indian system works, it’s unlikely that’s going to happen. This is why educating patients who know what questions to ask is the more effective way for now of making sure that IVF doctors can no longer get away with their careless habits.